At XiFin, a culture of inclusivity is in our very fabric. We believe that this culture not only creates a more equitable and functional workplace, but also enhances our team members' work experiences by promoting creativity, innovation, and collaboration.
Who are we looking for?
The Payor Relations Specialist plays a key role in fostering and maintaining positive relationships between health plans and providers. This position is responsible for identifying payer setup requirements for pharmacy claim submission, researching medical policy details across various payers, and ensuring billing requirements are up-to-date. The role also involves coordinating products as they relate to payers and policies, monitoring changes in pricing and fee schedules, and working closely with the Level 2 support team to ensure accurate and timely updates. This position requires a detail-oriented, and proactive individual who thrives in a collaborative team environment and possesses excellent verbal and written communication skills.
You may be hired as an Associate Specialist, or Specialist based on your depth of skill and breadth of experience.
What will you do?
- Build and maintain relationships: Develop strong working relationships with health plans and providers to ensure smooth communication and collaboration.
- Payer setup and pharmacy claim submission: Identify and understand payer-specific setup requirements for pharmacy claim submissions to ensure accuracy and compliance.
- Research medical policies: Analyze and research medical policies across various payers to stay informed of any updates, changes, or compliance requirements.
- Ensure up-to-date billing requirements: Continuously monitor and review payer billing requirements, ensuring that all information is current and aligns with policies.
- Coordinate new product rollouts: Work closely with internal teams to support the coordination and integration of new products in relation to payer policies.
- Monitor pricing and fee schedules: Track and monitor changes in payer pricing and fee schedules to ensure alignment and accuracy across systems.
- Collaborate with Level 2 support: Partner with the Level 2 support team to facilitate the timely and accurate implementation of any updates to payer or provider information.
- Maintain documentation: Ensure all relevant documentation, updates, and interactions are recorded accurately and kept up-to-date.
This is an onsite position at our office in Charleston, SC, Dallas, Texas, or San Diego, CA office. Consideration will be given to an employees existing location.
What education and experience do you need?
A combination of the following education and experience factors will be considered:
- High school diploma or equivalent required; additional certifications or specialized training in healthcare, payer relations, or pharmacy claims is a plus.
- Relevant work experience in payer relations, provider coordination, healthcare billing, or medical claims management (2+ years preferred).
- Strong understanding of payer policies, medical claims processes, and healthcare billing practices.
- Familiarity with pharmacy claim submissions and medical policy research is highly desirable.
- Experience using healthcare management systems or payer-related software tools is beneficial.
- Ability to communicate effectively with providers, health plans, and internal teams, both verbally and in writing.
- Strong attention to detail with a focus on accuracy and timeliness in completing tasks.
- Proven ability to work independently and as part of a team, showing flexibility in a fast-paced environment.
- Knowledge of applicable state, federal, and third-party regulations and standards (preferred).
- Provider relations experience (preferred).
What’s in it for me?
We don't just offer benefits; we offer a comprehensive and flexible benefits package tailored for you!
- Dive into a world of cutting-edge healthcare with our comprehensive medical, dental and vision benefits, including telehealth services. Say goodbye to the hassle of prescriptions with our convenient mail-order program for 90-day maintenance medications.
- Our Health Savings Account (HSA) featuring pre-tax deductions and quarterly company contributions (HSA only) puts more money in your pockets!
- Plan for your golden years with confidence through our 401k retirement plan, complete with a company match.
- Fuel your ambition with our Tuition Assistance program, empowering you to reach new heights in your professional journey.
- Finally, experience true well-being with XiFin's BeWell Program, where we champion physical, mental, financial, and social wellness, because your success and happiness are our ultimate priorities
Why XiFin?
XiFin is a healthcare information technology company that empowers healthcare organizations to navigate an increasingly complex and evolving healthcare landscape. Through innovative AI-enabled technologies and services, we deliver operational efficiency, interoperability, and simplicity. The company’s revenue cycle management, clinical workflow enablement, laboratory information system, and patient engagement solutions enable organizations to achieve stronger finances, streamline operations, and develop industry-leading business strategies.
Helping healthcare providers achieve financial strength empowers them to do more good for more people. That’s THE POWER TO DO GOOD.
What does the position pay:
Compensation is determined by several factors which may include skillset, experience level, and geographic location.
The expected range for this role is $17.00-$19.50 hourly compensation. Please note this range is an estimate and actual may vary based on qualifications and experience.
If you are an individual with a disability and would like to request a reasonable accommodation as part of the application or recruiting process, please contact us at 858-436-2901.
EEO Statement
XiFin is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
